Mullins #158541 v. NaphCare Health Incorporated et al

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WO MGD
IN THE UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF ARIZONA
Isaac John William Mullins,
Plaintiff,
v.
NaphCare Health Inc., et al.,
Defendants.
No. CV-25-00162-TUC-SHR
ORDER
Plaintiff Isaac John William Mullins, who is currently confined in the Arizona State
Prison Complex-Tucson, filed this pro se civil rights action pursuant to 42 U.S.C. § 1983.
Before the Court are Plaintiff’s Motion for Preliminary Injunction (Doc. 5) and Motion to
Supplement Reply (Doc. 65).
I. Background
Plaintiff’s Complaint alleges Defendants failed to provide adequate medical care for
his gastrointestinal (GI) issues (Count One), ongoing pain and neurological issues (Count
Two), and pulmonary/cardiac issues (Count Three).1 (Doc. 1.) Plaintiff alleges Defendants
have refused to schedule him to see specialists for his medical conditions and/or have
disregarded specialists’ recommendations for treatment pursuant to a policy, practice, or
custom of Defendant NaphCare.
1 Plaintiff has filed several other motions, including a motion for leave to file an
amended complaint (Doc. 30). The Court will address those motions by separate order(s).
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On screening under 28 U.S.C. § 1915A(a), the Court determined Plaintiff had stated
Eighth Amendment medical care claims in Counts One, Two, and Three against
Defendants NaphCare and Arizona Department of Corrections Rehabilitation and Reentry
(ADCRR) Director Ryan Thornell, in his official capacity, and against the following
Defendants in their individual capacities: Nurse Practitioners Alice Warren, Shannon
Welch, Christie Thornberry, and Unknown Ceballos; Registered Nurse Unknown Virgin;
Grievance Responders Sydney Flick and Robin Myers; Facility Health Administrator
Jennifer Davie; Assistant Director of Nursing Alicia Germany; Medical Directors Drs.
Samina Rahman and Adeyimika Omololu; and Site Medical Director Abel Salazar. (Doc.
12.) The Court further determined Plaintiff had stated a state law claim in Count Four for
medical malpractice and failure to supervise against all Defendants except Thornell.
The Court directed Defendants to answer the claims against them and directed
Defendants NaphCare and Thornell to respond to Plaintiff’s Motion for Preliminary
Injunction for immediate medical care once they had been served. (Id.) Defendants
NaphCare and Thornell filed their response to Plaintiff’s Motion for Preliminary Injunction
on August 28, 2025, and, due to service issues with Defendants’ Response, Plaintiff filed
his Reply on November 5, 2025, and a supplement to his reply on November 14, 2025.2
(Docs. 36, 60, 65.)
II. Legal Standards
A. Injunctive Relief
“A preliminary injunction is ‘an extraordinary and drastic remedy, one that should
not be granted unless the movant, by a clear showing, carries the burden of persuasion.’”
Lopez v. Brewer, 680 F.3d 1068, 1072 (9th Cir. 2012) (quoting Mazurek v. Armstrong, 520
U.S. 968, 972 (1997) (per curiam)); see also Winter v. Nat. Res. Def. Council, Inc., 555
U.S. 7, 24 (2008) (stating “[a] preliminary injunction is an extraordinary remedy never
awarded as of right”). Nonetheless, “federal courts ‘must not shrink from their obligation
2 The Court will grant Plaintiff’s Motion to Supplement his Reply (Doc. 65) with
evidence he says was not available to him when he filed his Reply the week before.
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to enforce the constitutional rights of all persons, including prisoners’” and must not “allow
constitutional violations to continue simply because a remedy would involve intrusion into
the realm of prison administration.” Porretti v. Dzurenda, 11 F.4th 1037, 1047 (9th Cir.
2021) (quoting Brown v. Plata, 563 U.S. 493, 511 (2011)).
A plaintiff seeking a preliminary injunction must show: (1) he is likely to succeed
on the merits; (2) he is likely to suffer irreparable harm in the absence of injunctive relief;
(3) the balance of equities tips in his favor; and (4) an injunction is in the public interest.
Winter, 555 U.S. at 20. When the government opposes a preliminary injunction, “[t]he
third and fourth factors of the preliminary-injunction test—balance of equities and public
interest—merge into one inquiry.” Porretti, 11 F.4th at 1050. The “balance of equities”
concerns the burdens or hardships to a prisoner complainant compared with the burden on
the government defendants if an injunction is ordered. Id. The public interest mostly
concerns the injunction’s impact on nonparties rather than parties. Id. Regardless, “[i]t is
always in the public interest to prevent the violation of a party’s constitutional rights.” Id.
(citation omitted).
The Ninth Circuit has articulated an alternate formulation of the Winter test referred
to as the “serious questions” or “sliding scale” approach: a preliminary injunction is
appropriate if a plaintiff can show “serious questions going to the merits,” “the balance of
hardships tips sharply in the plaintiff’s favor,” and the other two Winter factors are
satisfied. All. for the Wild Rockies v. Cottrell, 632 F.3d 1127, 1134–35 (9th Cir. 2011)
(explaining “the ‘serious questions’ approach survives Winter when applied as part of the
four-element Winter test”). Under this “serious questions” version of the sliding-scale test,
the elements of the preliminary-injunction test are balanced such that a stronger showing
of one element may offset a weaker showing of another. See id. at 1135.
Where a plaintiff seeks a mandatory injunction rather than a prohibitory injunction,
injunctive relief is “subject to a higher standard” and is “permissible when ‘extreme or very
serious damage will result’ that is not ‘capable of compensation in damages,’ and the merits
of the case are not ‘doubtful.’” Hernandez v. Sessions, 872 F.3d 976, 999 (9th Cir. 2017)
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(quoting Marlyn Nutraceuticals, Inc. v. Mucos Pharma GmbH & Co., 571 F.3d 873, 879
(9th Cir. 2009)). “This standard does not supersede the Ninth Circuit’s ‘serious questions’
test. Rather, the severity of the legal questions correlates with a movant’s likelihood of
success; the greater the likelihood of success, the less doubtful the case.” Morrar v. United
States, No. 2:19-cv00833-KJM-KJN, 2019 WL 2715618, at *4 (E.D. Cal. June 28, 2019).
Under the Prison Litigation Reform Act, injunctive relief must be narrowly drawn
and be the least intrusive means necessary to correct the harm. 18 U.S.C. § 3626(a)(2); see
Gilmore v. California, 220 F.3d 987, 999 (9th Cir. 2000).
When evaluating the merits of a preliminary-injunction motion, a court’s factual
findings and legal conclusions are not binding at a trial on the merits. Univ. of Texas v.
Camenisch, 451 U.S. 390, 395 (1981).
B. Eighth Amendment
To support a medical care claim under the Eighth Amendment, a prisoner must
demonstrate “deliberate indifference to serious medical needs.” Jett v. Penner, 439 F.3d
1091, 1096 (9th Cir. 2006) (quoting Estelle v. Gamble, 429 U.S. 97, 104 (1976)). There
are two prongs to the deliberate-indifference analysis: an objective standard and a
subjective standard. First, a prisoner must show a “serious medical need.” Id. A “‘serious’
medical need exists if the failure to treat a prisoner’s condition could result in further
significant injury or the ‘unnecessary and wanton infliction of pain.’” McGuckin v. Smith,
974 F.2d 1050, 1059 (9th Cir. 1992), overruled on other grounds by WMX Techs., Inc. v.
Miller, 104 F.3d 1133, 1136 (9th Cir. 1997) (en banc). Examples of indications a prisoner
has a serious medical need include “[t]he existence of an injury that a reasonable doctor or
patient would find important and worthy of comment or treatment; the presence of a
medical condition that significantly affects an individual’s daily activities; or the existence
of chronic and substantial pain.” Id. at 1059–60.
Second, a prisoner must show the defendant’s response to that need was deliberately
indifferent. Jett, 439 F.3d at 1096. To show deliberate indifference, a plaintiff “must show
. . . the course of treatment the doctors chose was medically unacceptable under the
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circumstances” and the defendants “chose this course in conscious disregard of an
excessive risk to the plaintiff's health.” Hamby v. Hammond, 821 F.3d 1085, 1092 (9th
Cir. 2016) (citation omitted). “Prison officials are deliberately indifferent to a prisoner’s
serious medical needs when they ‘deny, delay or intentionally interfere with medical
treatment.’” Wood v. Housewright, 900 F.2d 1332, 1334 (9th Cir. 1990) (quoting
Hutchinson v. United States, 838 F.2d 390, 394 (9th Cir. 1988)). Deliberate indifference
may also be shown where prison officials fail to respond to a prisoner’s pain or possible
medical need. Jett, 439 F.3d at 1096. “In deciding whether there has been deliberate
indifference to an inmate’s serious medical needs, [courts] need not defer to the judgment
of prison doctors or administrators.’” Colwell v. Bannister, 763 F.3d 1060, 1066 (9th Cir.
2014) (quoting Hunt v. Dental Dep’t, 865 F.2d 198, 200 (9th Cir. 1989)).
Even if deliberate indifference is shown, to support an Eighth Amendment claim,
the prisoner must demonstrate harm caused by the indifference. Jett, 439 F.3d at 1096; see
Hunt, 865 F.2d at 200 (stating delay in providing medical treatment does not constitute
Eighth Amendment violation unless delay was harmful).
III. Plaintiff’s Motion for Preliminary Injunction
Plaintiff’s Motion seeks an order requiring Defendants to provide him with various
medications, equipment, surgery, and specialist appointments for his GI, orthopedic,
neurological, and pulmonary/cardiac issues. (Doc. 5-1 at 1–2.)
A. Pulmonary/Cardiac Issues
1. Relevant Facts
On June 13, 2024, Plaintiff saw pulmonologist Dr. Ramit Sharma, MD, for a follow-
up appointment. Dr. Sharma diagnosed Plaintiff with dyspnea, a history of acute
pulmonary emboli, “[r]epeat pulmonary embolus, January 2023 (was taking Eliquis 5 mg
[(milligrams)] PO BID at the time),” and “Pulmonary HTN [(hypertension)], WHO Group
IV.” (Doc. 36-2 at 41.) Plaintiff had 13 medications on his list of current medications,
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including Opsumit, Adempas, and Eliquis.3 (Id. at 40.) Dr. Sharma’s plan of care was to
“continue with current therapy,” supplement Plaintiff’s “oxygen at night continuously,”
have him enroll in cardiopulmonary rehab so he “knows the exercise routines,” and return
for a follow-up visit in 3 months. (Id.) In Plaintiff’s history, Dr. Sharma noted Plaintiff
“does not require supplemental oxygen during the day but he will require supplemental
oxygen continuously during the night. As for active exercises, [Plaintiff] can do slow
cardio exercises.” (Id. at 40.) Plaintiff was not sent for cardiopulmonary rehabilitation.
(Pl. Decl. (Doc. 5 at 14–22) ¶¶ 38, 39.)
On September 16, 2024, Plaintiff saw DNP Chandra Sorrelle at Sonoran
Pulmonology for a three-month follow-up appointment. (Doc. 36-2 at 42, 44.) Plaintiff
reported he had been feeling better overall since he began taking Adempas and Opsumit
several months earlier and felt better having supplemental oxygen at night. (Id. at 43.)
Sorrelle determined Plaintiff had chronic respiratory failure with hypoxia, pulmonary
arterial hypertension, and pulmonary embolism. (Id. at 44.) Sorrelle’s plan of care for
Plaintiff’s pulmonary arterial hypertension was to “[r]epeat 2D echo[cardiogram] in
October to monitor RVSP [(right ventricular systolic pressure)],” continue Adempas and
3 Opsumit—the brand name for Macitentan—“treats symptoms of pulmonary
arterial hypertension, which is high blood pressure in the main artery that carries blood
from the right side of the heart (the ventricle) to the lungs.” Mayo Clinic, Macitentan (oral
route), at https://www.mayoclinic.org/drugs-supplements/macitentan-oral-
route/description/drg-20061394 (permalink: https://perma.cc/HT8Q-TPS8).
Adempas is the brand name for Riociguat, which “is used to treat adults with chronic
thromboembolic pulmonary hypertension (CTEPH) that can be treated with surgery, or that
cannot be treated with surgery.” Mayo Clinic, Riociguat (oral route), at
https://www.mayoclinic.org/drugs-supplements/riociguat-oral-route/description/drg-
20061342 (permalink: https://perma.cc/KUD4-DZ5B).
Eliquis is the brand name for Apixaban, which “is used to treat or prevent deep
venous thrombosis, a condition in which harmful blood clots form in the blood vessels of
the legs. These blood clots can travel to the lungs and can become lodged in the blood
vessels of the lungs, causing a condition called pulmonary embolism.” Mayo Clinic,
Apixaban (oral route), at https://www.mayoclinic.org/drugs-supplements/apixaban-oral-
route/description/drg-20060729 (permalink: https://perma.cc/4GES-GDA5).
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Opsumit, and have Plaintiff participate in the recommended cardiopulmonary
rehabilitation. (Id.) For chronic respiratory failure with hypoxia, Sorrelle planned for
Plaintiff to continue supplemental oxygen at night and recommended Plaintiff have
supplemental oxygen available during the day “as his SpO2 [(saturation of peripheral
oxygen)] is likely dropping to 88% or lower when engaging in activity for longer than 6
minutes; especially when outside.” (Id.) Sorrelle also noted Plaintiff needed access to a
pulse oximeter to monitor his “SpO2 as he needs to use supplemental oxygen when 88%
or lower.” (Id.) Sorrelle said Plaintiff was to follow up in November for a “2D
echo[cardiogram] & Distance walk.” (Id.) At the appointment, Plaintiff told Sorrelle he
had not been to cardiopulmonary rehabilitation, and Sorrelle said she would make a second
referral. (Pl. Decl. ¶ 40.) When Plaintiff told Sorrelle NaphCare still refused to provide
him with a portable oxygen concentrator (POC) and he avoided using the large oxygen
tank provided due to pain, Sorrelle advised Plaintiff to use a pulse oximeter to ensure his
oxygen level did not drop below 88% when active. (Id.) Plaintiff has not received a pulse
oximeter or cardiopulmonary rehabilitation. (Id. ¶ 41.)
On February 10, 2025, Plaintiff saw Shantha Kumar, MD, at Goldfield
Cardiovascular Institute in Tucson “for echo[cardiogram] and cardiac clearance” because
Plaintiff was contemplating spinal injections for spinal stenosis. (Doc. 36-2 at 49–50.) Dr.
Kumar examined Plaintiff, assessed him with chronic thromboembolic pulmonary
hypertension (CTEPH) and dizziness, noted his echocardiogram done that day showed his
pulmonary artery pressure was improving, and, from a cardiac standpoint, there was no
contraindication to undergoing epidural injections for spinal stenosis, but Eliquis needed
to be stopped 5 days before the procedure. (Id. at 50.) As for the dizziness and unstable
gait Plaintiff complained of, Dr. Kumar noted these symptoms may be secondary to
systemic hypotension, which can be caused by Plaintiff’s vasodilator medications. (Id.)
Dr. Kumar recommended Plaintiff’s blood pressure be checked the next time he is dizzy
and, if it is low, Dr. Kumar encouraged Plaintiff to consume water and salt-containing
fluids to keep his blood pressure up. (Id.)
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On April 4, 2025, Plaintiff saw DNP Sorrelle at Sonoran Pulmonology to review a
2D echocardiogram, which showed his right ventricular systolic pressure had “decreased
further down to 39 mmHg.” (Doc. 36-6 at 2.) Plaintiff declined a distance walk because
he felt his equilibrium was off that day. (Id.) Plaintiff reported he felt better while taking
Adempas and Opsumit, but there had been several occasions when he ran out of the
medications for 6 to 7 days. (Id.) Plaintiff also reported he felt better after using
supplemental oxygen at night but did not use supplemental oxygen with activity as much
as he should because it hurt to drag the tank around due to his torn shoulder. (Id.)
Following an exam, Sorrelle diagnosed Plaintiff with chronic respiratory failure with
hypoxia, pulmonary arterial hypertension, and pulmonary embolism. (Id. at 3.) The plan
of care for pulmonary arterial hypertension was to continue Adempas and Opsumit, to
consider adding another “pathway medication in the future,” and to repeat the 2D
echocardiogram in 6 to 12 months. (Id.) Sorrelle noted in bold: “Extremely important
p[atien]t NOT run out of medications a[s] this can cause severe rebound [p]ulmonary
[hypertension] which can be fatal.” (Id.) Sorrelle also wrote in bold that Plaintiff “must
continue to see Pulmonary for CTEPH as this is a subspecialty within Pulmonology
which requires specialized treatment/medications and monitoring.” (Id.) The plan for
chronic respiratory failure with hypoxia was to continue supplemental oxygen at night, and
DNP Sorrelle again recommended Plaintiff have supplemental oxygen available during the
day. (Id.) Sorrelle further advised Plaintiff “needs to have access to pulse oximeter to
monitor his SpO2 as he needs to use supplemental oxygen when 88% or lower.” (Id.) The
plan for pulmonary embolism was to continue taking Eliquis twice daily. (Id.)
On August 5, 2025, Plaintiff saw Dr. Juliya Cress, MD, at Carondelet Medical
Group in Tucson to establish care for preoperative risk assessment prior to orthopedic
surgery for cubital tunnel release surgery. (Doc. 65-1 at 2.) Dr. Cress took Plaintiff’s
medical history, but no physical exam was recorded. (See id. at 2–3.) The assessment was
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pulmonary hypertension; Dr. Cress ordered an ultrasound and echocardiogram and noted
Plaintiff was to return to the office as needed.4 (Id. at 2–3.)
On August 6, 2025, Plaintiff again saw DNP Sorrelle at Sonoran Pulmonology for
a “follow-up to review PFT [(pulmonary function test)] and for clearance for cubital tunnel
release” surgery. (Doc. 60-3 at 9.) Sorrelle noted Plaintiff was unable to complete the PFT
because he could not exhale for 6 seconds. (Id.) Plaintiff again reported he does not use
oxygen with activity as much as he should because he has a torn shoulder, and the prison
will not give him a POC to use. (Id.) Sorrelle wrote that during an ambulation study,
Plaintiff started at 98% on room air at rest and within 3 minutes dropped to 78% on room
air but recovered up to 97% within a few seconds of sitting down. (Id.) Sorrelle again
assessed Plaintiff with pulmonary arterial hypertension, chronic respiratory failure with
hypoxia, and pulmonary embolism. (Doc. 60-3 at 9–10.) Sorrelle’s treatment plan for the
pulmonary arterial hypertension was to continue Adempas and Opsumit and to consider
adding Prostacycline pathway medication in the future and to repeat a 2D echocardiogram
no later than February 2026. (Id. at 10.) Sorrelle again noted in bold: “Extremely
important p[atien]t NOT run out of medications a[s] this can cause severe rebound
[p]ulmonary [hypertension] which can be fatal.” (Id.) Sorrelle also wrote in bold that
Plaintiff “must continue to see Pulmonary for CTEPH as this is a subspecialty within
Pulmonology which requires specialized treatment/medications and monitoring.”
(Id.) For Plaintiff’s chronic respiratory failure with hypoxia, Sorrelle’s treatment plan was
to continue supplemental oxygen during the night. (Id.) Sorrelle also recommended
Plaintiff “have POC available during the day as his SpO2 drops to 78% on RA after only
3 minutes of activity.” (Id.) She further “[r]ecommend[ed] [an] order for oximetry
monitoring while [Plaintiff is] awake and engaging in activity to determine how long
SpO2 is dropping when he is active during the day.” (Id.) The treatment plan for
4 Dr. Cress did not note if Plaintiff was cleared for cubital tunnel release surgery at
that time or if the ultrasound and echocardiogram were needed before making that
determination.
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pulmonary embolism was to continue Eliquis. (Id.) Although Plaintiff could not complete
the PFT, Sorrelle noted Plaintiff “may proceed with planned surgery from a pulmonary
perspective with the following recommendation of avoiding general anesthesia,
hypervolemia and maintaining SpO2 above 94% during procedure.” (Id.)
On August 13, 2025, Corporate Nurse Practitioner Melissa Ceballos noted a request
for a personal pulse oximeter was denied by the facility health administrator. (Doc. 36-28
at 2.)
On August 28, 2025, Defendant NP Alice Warren noted Plaintiff had been
transported to an offsite cardiology consultation on August 5, 2025, and an offsite
pulmonology consultation on August 6, 2025, and had been seen for fecal incontinence.
(Doc. 36-28 at 2–3.) Regarding the pulmonology consult, Warren noted Plaintiff was to
continue Adempas and Opsumit, “6 weeks to review oximetry during the day,” “follow up
4–6 months no later than February 2026 for 2D echo[cardiogram],” and Plaintiff could
proceed with planned surgery from a pulmonology perspective. (Doc. 36-28 at 2–3.)
Regarding the request for a pulse oximeter, the record says Plaintiff was “advised
Manzanita has 24 hour nursing staff available to check pulse oximeter.” (Id. at 3.)
Regarding the cardiology consult, Warren noted Plaintiff had not been “cleared for
surgery” and the doctor had requested several imaging studies including an ultrasound and
echocardiogram. (Id.) Regarding fecal incontinence, Warren noted Plaintiff reported his
GI symptoms started in February 2023, his first episode of incontinence was in July 2024
before starting Tramadol, and episodes had decreased since starting Tramadol in May
2025. (Id.) Warren’s plan of care stated “RFO Pulmonology consult - consult ordered -
pulse oximetry ordered”; “RFO Cardiology consult - consult ordered”; and “Evaluation for
fecal incontinence - provider note attached to Gastroenterology consult. HNR [(Health
Needs Request)] as needed.” (Id. at 4.)
2. Discussion
For his pulmonary/cardiac issues, Plaintiff asks the Court to order that he be
provided a POC, a pulse oximeter, cardiopulmonary rehab, and an appointment with his
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treating pulmonologist. (Doc. 5-1 at 1–2.) Plaintiff asserts he suffers from shortness of
breath with physical activity, dizziness, poor equilibrium, and diminished cognitive
function, which he believes are related to his lung disease and NaphCare’s failure to follow
the pulmonologist’s recommendations. (Pl. Decl. ¶ 43.)
There is no dispute Plaintiff’s pulmonary/cardiac issues are “worthy of comment or
treatment” as revealed by his medical records showing he has been receiving care at the
prison, consultations with outside specialists, testing, medications, and supplemental
oxygen for these issues. This evidence satisfies the objective prong of the deliberate
indifference analysis. See McGuckin, 974 F.2d at 1059–60.
The subjective prong of the deliberate indifference analysis is satisfied by showing
(a) a purposeful act or failure to respond to a prisoner’s pain or possible medical need and
(b) harm caused by the indifference. Jett, 439 F.3d at 1096. Where a plaintiff seeks
injunctive relief, the deliberate indifference determination is based on the defendant’s
current conduct. Farmer v. Brennan, 511 U.S. 825, 845 (1994).
The Court will review the likelihood of success on the deliberate indifference prong
with respect to each of Plaintiff’s requested forms of relief.
a. Portable Oxygen and Pulse Oximeter
As for the specialist recommendations that Plaintiff have portable oxygen available
during the day and oximetry monitoring while awake, Defendants assert Plaintiff resides
in a medical unit in which he has 24-hour access to oxygen and a pulse oximeter. (Doc.
36 at 5.) Defendants contend Plaintiff simply disagrees with the type of portable oxygen
provided in his unit. (Id. at 9.)
Plaintiff presents evidence the oxygen tank provided in the medical unit is heavy
and hurts his shoulder, so he does not use it as often as he should during the day. Plaintiff
states he has been housed with another prisoner who was provided a portable oxygen unit
called an Inogen, demonstrating precedent for receiving a POC.
The evidence reflects the pulmonologist recommended a POC on August 6, 2025,
after Plaintiff told the pulmonologist he did not use the oxygen tank provided at the prison
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as much as he should because he has a torn shoulder, and the prison would not give him a
lighter-weight POC to use. The pulmonologist recommended a POC be available during
the day because Plaintiff’s oxygen level drops to 78% after only 3 minutes of activity.
Although Defendants contend Plaintiff has oxygen available in his medical unit, there is
no evidence the available oxygen is sufficient if Plaintiff is outside his unit or engaging in
activity, especially since testing at the pulmonologist’s office showed Plaintiff’s oxygen
dropped to a dangerously low level after only 3 minutes of activity. Similarly, although a
pulse oximeter may be available in the medical unit, there is no evidence that availability
is sufficient, particularly when Plaintiff is outside his unit. Accordingly, there are questions
of fact as to whether Defendants have been deliberately indifferent to Plaintiff’s serious
medical need by failing to follow the pulmonologist’s recommendations for a POC and
pulse oximeter.
The Ninth Circuit and other courts have routinely found failure to follow a
specialist’s recommendation may amount to a medically unacceptable course of treatment.
See Colwell, 763 F.3d at 1069 (denying summary judgment where prison officials “ignored
the recommendations of treating specialists and instead relied on the opinions of non-
specialist and non-treating medical officials who made decisions based on an
administrative policy”); Snow v. McDaniel, 681 F.3d 978, 988 (9th Cir. 2012) (stating
where the treating physician and specialist recommended surgery, a reasonable jury could
conclude it was medically unacceptable for the non-treating, non-specialist physicians to
deny recommendations for surgery), overruled on other grounds by Peralta v. Dillard, 744
F.3d 1076, 1083 (9th Cir. 2014); Jones v. Simek, 193 F.3d 485, 490 (7th Cir. 1999) (stating
defendant physician’s refusal to follow the advice of treating specialists could constitute
deliberate indifference to serious medical needs); McNearney v. Wash. Dep’t of Corrs.,
C11-5930 RBL/KLS, 2012 WL 3545267, at *26 (W.D. Wash. June 15, 2012) (in granting
a preliminary injunction for specialist treatment, district court found the prisoner plaintiff
had shown a likelihood of success on the merits of her Eighth Amendment claim where the
defendants failed to follow an orthopedic surgeon’s strong recommendation for further
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orthopedic evaluation). In addition, a failure to competently treat a serious medical
condition, even if some treatment is prescribed, may constitute deliberate indifference
under certain circumstances. See Ortiz v. City of Imperial, 884 F.2d 1312, 1314 (9th Cir.
1989) (stating “access to medical staff is meaningless unless that staff is competent and
can render competent care”); Estelle, 429 U.S. at 104–05 & n.10 (explaining treatment
received by a prisoner can be so inadequate that the treatment itself manifests deliberate
indifference); Lopez v. Smith, 203 F.3d 1122, 1132 (9th Cir. 2000) (holding prisoner does
not have to prove he was completely denied medical care).
On the record before the Court, Plaintiff has shown a likelihood of success on the
merits of his deliberate indifference claim regarding the treatment of his pulmonary/cardiac
issues, particularly the denial of a POC and pulse oximeter. While the record shows
Plaintiff has been receiving some treatment, and oxygen and a pulse oximeter are available
in the medical unit, the inference from the available evidence is that the treatment is
inadequate. A reasonable jury could find, under these circumstances, Defendants failed to
competently treat Plaintiff’s pulmonary/cardiac issues and acted with deliberate
indifference.
In addition to showing a likelihood of success, Plaintiff must demonstrate that
absent an injunction, he will be exposed to irreparable harm. Caribbean Marine Servs.
Co., Inc. v. Baldrige, 844 F.2d 668, 674 (9th Cir. 1988) (stating speculative injury is not
irreparable injury sufficient for a preliminary injunction); see Winter, 555 U.S. at 22. To
support a mandatory preliminary injunction for specific medical treatment, a plaintiff must
demonstrate ongoing harm or the present threat of irreparable injury, not a past injury. See
Connecticut v. Massachusetts, 282 U.S. 660, 674 (1931) (stating an injunction is only
appropriate “to prevent existing or presently threatened injuries”); Caribbean Marine, 844
F.2d at 674. “[T]here must be a presently existing threat of harm, although injury need not
be certain to occur.” Villaneuva v. Sisto, CIV S-06-2706 LKK EFB P, 2008 WL 4467512,
at *3 (E.D. Cal. Oct. 3, 2008) (citing FDIC v. Garner, 125 F.3d 1272, 1279–80 (9th Cir.
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1997)). Plaintiff has demonstrated the threat of irreparable harm where the evidence
reflects his oxygen level drops to 78% after only 3 minutes of activity.
Accordingly, the Court will grant Plaintiff’s Motion for injunctive relief for a
portable oxygen concetrator and a pulse oximeter.
b. Cardiopulmonary Rehabilitation
The record reflects Plaintiff’s treating pulmonologists—Dr. Sharma and DNP
Sorrelle—made recommendations for cardiopulmonary rehabilitation on June 13, 2024,
and September 16, 2024. Defendants assert instead of sending Plaintiff for
cardiopulmonary rehabilitation, NaphCare recommended an alternative treatment plan,
including continued medication management, education regarding diet and exercise for
management of symptoms, education regarding management of stress/anxiety to prevent
exacerbation of symptoms, and lifestyle modifications. (Doc. 36 at 9.) Defendants contend
Plaintiff’s vitals have been stable, and the specialists at Plaintiff’s most recent visits with
the cardiologist and pulmonologist on August 5 and 6, 2025, did not include additional
recommendations for cardiopulmonary rehabilitation. (Id. at 9–10.)
On this record, there is a question of fact whether Defendants were deliberately
indifferent to Plaintiff’s serious medical need when they failed to follow the treating
specialists’ recommendations for cardiopulmonary rehabilitation. See Colwell, 763 F.3d
at 1069; Snow, 681 F.3d at 988. However, those specialists’ recommendations were made
over a year ago and it is not clear if Plaintiff’s treating specialist(s) are still recommending
cardiopulmonary rehabilitation or if Plaintiff is being harmed by the lack of
cardiopulmonary rehabilitation at this time. Therefore, the Court will deny Plaintiff’s
request for cardiopulmonary rehabilitation. But if the specialist recommends
cardiopulmonary rehabilitation at Plaintiff’s next specialist visit, and Defendants do not
provide the cardiopulmonary rehabilitation, Plaintiff may file a new motion for injunctive
relief requesting Defendants provide specialist-recommended cardiopulmonary
rehabilitation.
. . . .
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c. Appointment with Pulmonologist
The record reflects Plaintiff’s most recent pulmonology appointment was the
August 6, 2025 visit with DNP Sorrelle at Sonoran Pulmonology. At that visit, Sorrelle
indicated Plaintiff was to repeat a 2D echocardiogram no later than February 2026. On
August 28, 2025, Defendant NP Warren noted Plaintiff was to follow up with pulmonology
for the 2D echocardiogram no later than February 2026. There is no evidence in the record
Plaintiff was supposed to see the pulmonologist prior to February 2026, and the Court will
therefore deny this request in Plaintiff’s Motion. If the follow-up appointment with the
specialist does not occur by February 2026, Plaintiff may again file a request for injunctive
relief to be sent to the pulmonologist.
B. Orthopedic/Pain/Neurological Issues
1. Relevant Facts
Plaintiff’s neck and shoulder pain progressively worsened after a stay in the
infirmary in June 2023, and by October 2023 he could no longer sleep without constantly
waking up in excruciating pain extending from his neck down through his shoulders and
causing temporary paralysis in those areas. (Pl. Decl. ¶ 16.) Plaintiff also had severe daily
headaches and incessant pain in his cervical spine (“c-spine”) during the day radiating
down through his shoulders and arms. Plaintiff’s shoulders were so injured that his range
of motion was severely limited and almost every movement was painful. (Id.)
Plaintiff submitted HNRs asking to have his previously prescribed pain medications
renewed, but when he met with Defendant NP Warren, Warren accused him of seeking
pain medication to get high, opined Plaintiff was malingering, and said she would not
prescribe any medication other than what Plaintiff was already receiving—Tylenol and
lidocaine patches—even though Plaintiff had told her those were ineffective. (Pl. Decl.
¶ 17.) As a result, Plaintiff suffered severe and unnecessary pain for 5 months. (Id.)
On March 26, 2024, Defendant Dr. Samina Rahman prepared an Offsite Healthcare
Authorization for Plaintiff to have an “MR C-spine with and without contrast” due to “pain
in neck on sleeping, radiates to both shoulders, wakes him at night, cervical spondylosis
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and other abnormalities on Xray.” (Doc. 36-2 at 15.) An Offsite Consultation Note by Dr.
Rahman indicates Plaintiff had an MRI—magnetic resonance imaging—of his c-spine on
May 13, 2024, and the results remained pending. (Id. at 16.)
On August 8, 2024, Plaintiff saw Dr. Shruti Badhwar, DO, a neurologist at Abrazo
Medical Group. Dr. Badhwar noted Plaintiff’s history of pulmonary hypertension from
pulmonary embolism as well as Plaintiff’s complaints of multiple medical problems
including dizziness, daily headaches that are not helped by over-the-counter pain
medication, worsening balance, neck and lower back pain, paresthesia, pain and numbness
in his hands and feet, and bowel incontinence. (Doc. 36-5 at 2, 4; Pl. Decl. ¶ 19.) Dr.
Badhwar planned for Plaintiff to have an MRI of his brain and an MRA—magnetic
resonance angiography—of his head and neck to assess his dizziness and for him to start
on vestibular therapy and Meclizine as needed. (Doc. 36-5 at 5.) She also recommended
various blood tests and occipital nerve blocks for his chronic daily headaches. (Id.) As for
the chronic lower back pain, Dr. Badhwar planned for Plaintiff to have an MRI of his
lumbar spine and electromyography (EMG) nerve conduction studies in his upper and
lower extremities to further evaluate the paresthesia and rule out underlying peripheral
neuropathy. She also started Plaintiff on 100 mg of Gabapentin 3 times daily. (Id.) The
neurologist told Plaintiff an orthopedist would need to review Plaintiff’s c-spine issues and
MRI results. (Pl. Decl. ¶ 19.)
On September 17, 2024, Plaintiff saw Dr. Badhwar again, and Plaintiff told her he
was still suffering from severe c-spine pain despite resuming Gabapentin, and she
recommended Plaintiff consult with a pain management specialist. (Doc. 36-2 at 28; Pl.
Decl. ¶ 21.) Dr. Badhwar assessed Plaintiff with a history of cervicogenic migraines and
occipital neuralgia for which she administered an occipital nerve block to see how the
migraines responded to the injection. (Doc. 36-2 at 28.) Dr. Badhwar recommended
Plaintiff increase Gabapentin to 300 mg 3 times daily for headaches and chronic neck pain
and noted she was awaiting Plaintiff’s imaging studies, including an MRI of Plaintiff’s
brain and MRA of Plaintiff’s head and neck. (Id.) Dr. Badhwar said if there was no
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improvement in the migraines with the higher dose of Gabapentin and the occipital nerve
block, she would consider adding Topamax for migraine prophylaxis, and she would like
Plaintiff to return for a follow-up appointment in 4 weeks or sooner if needed. (Id.)
On October 15, 2024, Plaintiff had nerve conduction studies and needle examination
at NeuroDiagnostic Laboratories in Tucson for his complaints of bilateral upper and lower
extremity pain, numbness, tingling, and weakness for the past 1.5 years. (Doc. 36-2 at 30.)
Dr. Alex Hlubocky, MD, interpreted the test results, finding they “are consistent with a left
ulnar neuropathy at the elbow. There is no convincing electrophysiological evidence of
large fiber peripheral neuropathy, left cervical/lumbosacral radiculopathy or lower
extremity/right upper extremity mononeuropathy.” (Id.)
On November 5, 2024, Plaintiff had several tests at St. Mary’s Hospital in Tucson.
A lumbar spine MRI revealed: “1. Mild spinal canal stenosis at L4–L5. Shallow left far
lateral protrusion approaching but not compressing the exiting left L4 nerve root. Moderate
left foraminal stenosis. 2. Shallow left L3–4 foraminal protrusion without nerve
compression. 3. No significant spinal stenosis.” (Doc. 36-14 at 6.) A right shoulder MRI
revealed: “1. Focal tear of the anterior superior through anterior glenoid labrum without
labral detachment. 2. Otherwise normal MRI right shoulder.” (Id. at 9.) A brain MRI
revealed: “1. No acute intracranial abnormality. Unremarkable unenhanced brain MRI.
2. Acute right frontal sinusitis.” (Id. at 8.) A neck MRA and thoracic spine MRI were both
“unremarkable.” (Doc. 36-14 at 4, 7.)
On November 27, 2024, Plaintiff met with Defendant Dr. Adeyimika Omololu and
asked her what could be done about the tear in his shoulder and pain in his lumbar spine
area, and Dr. Omololu recommended physical therapy or pain management. (Pl. Decl. ¶
22.) Plaintiff told the doctor that given his severe daily pain from multiple injuries, he felt
pain management should precede physical therapy, and Dr. Omololu concurred, stating she
would submit a pain management consultation request for Plaintiff’s lumbar spine and
shoulder followed by physical therapy. (Id.)
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On December 18, 2024, Plaintiff saw the neurologist, Dr. Badhwar, who examined
him and wrote the following Assessment/Plan:
The patient is a 44-year-old male with a history of cervicogenic
migraines and occipital neuralgia. He continues to experience
migraines and reports neck and lower back pain, along with
paresthesias. His MRI cervical spine from May 2024 showed
advanced degenerative spinal stenosis at C5–C6 with moderate
right and mild left foraminal narrowing. An EMG revealed
cubital tunnel syndrome on the left side, and sleep disturbances
are likely related to back pain.
For migraine prophylaxis, we have discussed starting Topamax
(topiramate). Additionally, he is being referred to hand surgery
for his cubital tunnel syndrome, to pain management for
consideration of epidural injections, and to orthopedics for
further evaluation of a potential labral tear. He is also advised
to increase his gabapentin dose to 600mg TID.
I recommend physical therapy for both his neck and back pain
and suggest trying an egg crate mattress topper for improved
sleep and pain relief. A follow-up appointment is scheduled in
4 weeks or sooner if needed to assess progress and adjust the
care plan as appropriate.
(Doc. 36-2 at 37.)
On January 15, 2025, Defendant NP Shannon Welch noted in Plaintiff’s medical
record that Plaintiff was scheduled for orthopedic surgery for his right shoulder, but
utilization management (UM) recommended the following conservative treatment instead:
“For focal tears initial treatment is usually non-surgical conservative measures (i.e.
NSAIDS, Tylenol, Ice, Brace/Sling, Physical Therapy etc.). Please initiate conservative
measures including PT and make sure trials and failures are documented in the chart. If
conservative treatment fails may submit new consult for reconsideration.” (Doc. 36-20 at
2.)
On January 29, 2025, Plaintiff reported to a physical therapist he was feeling better
after doing exercises and receiving a steroid injection on January 24, and the pain had died
down to a 3. (Doc. 36-18 at 3.)
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On January 30, 2025, Plaintiff was taken to a pain management clinic for a c-spine
epidural injection, but the doctor said NaphCare had failed to send the necessary MRI
report and had failed to take Plaintiff off Eliquis—a blood thinner—and therefore Plaintiff
could not receive the epidural. (Pl. Decl. ¶ 26.) Plaintiff asked what else could be done
for the unremitting pain and the doctor recommended an increase in Gabapentin. (Id.)
At physical therapy on February 5, 2025, Plaintiff reported right shoulder pain at
4/10 when attempting to perform weight-bearing exercises; he was advised not to do those
exercises until new imaging had been completed. (Doc. 36-18 at 5.) At physical therapy
on February 19, 2025, Plaintiff reported he did not have much pain in his shoulder but pain
in his neck had really been bothering him. (Id. at 7.) At physical therapy on March 5,
2025, Plaintiff reported decreased shoulder pain overall but increased cervical pain and it
was “hard to determine which is which.” (Id. at 9.) At physical therapy on March 11,
2025, Plaintiff reported his right shoulder felt okay but his left shoulder hurt with pain at
7/10. (Id. at 12.) At physical therapy on March 19, 2025, Plaintiff reported extreme
dizziness and unsteadiness during the past week and rated his c-spine and shoulder pain at
7/10. (Id. at 14.) On April 17, 2025, Plaintiff declined further physical therapy due to poor
tolerance and said he would wait until he receives a diagnosis and his condition is managed.
(Id. at 16.)
On March 18, 2025, Plaintiff saw an orthopedic surgeon, Dr. Christopher Luther,
DO, to establish care for his left elbow pain and numbness and tingling in his fingers
following an EMG performed on October 15, 2024, showing ulnar neuropathy at the elbow.
(Doc. 36-8 at 3.) Dr. Luther assessed left cubital tunnel syndrome and recommended left
cubital tunnel release surgery, which Plaintiff agreed to. (Doc. 36-19 at 7.)
On March 28, 2025, Plaintiff saw Defendant NP Welch, who asked why Plaintiff
had asked to stop shoulder PT, and Plaintiff explained PT caused severe pain in his c-spine,
left arm, and upper body. (Pl. Decl. ¶ 28.) Plaintiff’s untreated neurological symptoms of
poor equilibrium, deteriorating coordination, blurred vision, and occipital neuralgia also
rendered him unable to perform PT exercises. (Id.) Welch decided to stop PT and told
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Plaintiff she had submitted a referral on March 27, 2025, for cubital tunnel surgery as
recommended by the orthopedist. (Id.) Plaintiff asked if the c-spine epidural he was
supposed to receive in January had been rescheduled, and she said it had not, even though
Plaintiff told her the treatment had been recommended back in September 2024 and he was
still experiencing incessant and severe c-spine pain. (Id.) Welch said there was no point
in requesting further specialist referrals because they would just be denied again by UM.
(Id.)
On May 7, 2025, Plaintiff had a chronic care visit via telemedicine with NP Megan
Slattery, who noted Plaintiff had upcoming appointments scheduled for a “testicular US
[(ultrasound)]” on May 8, 2025; a right shoulder MRI on May 14, 2025; pain management
on May 23, 2025; left cubital tunnel release surgery on May 30, 2025; neurology on June
9, 2025; and pulmonology on August 4, 2025. (Doc. 36-9 at 1, 4, 9.)
On May 23, 2025, Plaintiff saw Dr. Vikramjeet Saini, MD, at Advanced Pain
Management for a follow up regarding multiple chronic pain issues including a history of
neck, shoulder, and lower back pain. (Doc. 36-3 at 2.) Plaintiff reported constant right
shoulder pain for the past two years due to a tear, lower back pain, and intensely radiating
neck pain. (Id. at 2–3.) He also reported Gabapentin helped with neuropathic pain but not
nociceptive pain, and Tylenol 500 mg patches and Duloxetine were ineffective for pain
management. (Id. at 3.) After examining Plaintiff, Dr. Saini assessed Plaintiff with
cervical spondylosis and cervical radiculopathy. (Id. at 4.) Dr. Saini noted Plaintiff had a
“complex pain presentation involving neck, shoulder, and low back pain,” with associated
headaches and occasional numbness and tingling in 3 fingers. (Id. at 6.) He also noted
MRI findings “correlate[] with the patient’s symptoms,” and the previous treatments
including oral medications and physical therapy had been ineffective. (Id.) Dr. Saini noted
“[t]he complex nature of the pain presentation, involving multiple sites and both
neuropathic and nociceptive components, necessitates a multifaceted approach to pain
management.” (Id.) Dr. Saini administered a cervical epidural steroid injection that day.
(Id. at 5.) Dr. Saini noted the prison had denied pain management for the right shoulder
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tear and lumbar spine issue and Dr. Saini wrote, “Consider ESI [epidural steroid injection]
on next visit.” (Id. at 6.)
A note by NP Slattery dated May 27, 2025, stated “ortho surgery left elbow cubital
tunnel release scheduled for 5/30/25 going to be cancelled . . . [and] rescheduled, pending
clearance needs blood work EKG chest xray etc. [P]atient states understanding [but] is
frustrated because he has held his Eliquis and feels this is just another delay on medical[’s]
part because this should have already been completed.” (Doc. 36-28 at 18–19.)
On June 9, 2025, Plaintiff saw neurologist Dr. Badhwar at Abrazo Brain & Spine
Institute. (Doc. 36-4 at 2.) Dr. Badhwar noted Plaintiff was an established patient with
ongoing neurological symptoms, muscle dysfunction, pain, and fecal incontinence. (Id. at
4.) Following examination, Dr. Badhwar assessed Plaintiff with cubital tunnel syndrome
as confirmed by EMG, cervical and lumbar spine arthritis, shoulder arthritis, chronic pain,
headaches, fecal incontinence, and possible fibromyalgia. (Id.) Dr. Badhwar noted surgery
for the cubital tunnel syndrome had been canceled by the prison’s medical contractor and
her plan was to refer Plaintiff to an orthopedic surgeon for evaluation and possible
rescheduling of surgery. (Id.) For the cervical and lumbar spine arthritis, Dr. Badhwar
noted an MRI showed moderate spinal stenosis in Plaintiff’s c-spine at C5–C6 and mild
spinal canal stenosis in lumbar spine at L4–L5, which may be contributing to Plaintiff’s
pain and neurological symptoms. (Id.) Dr. Badhwar’s plan was to refer Plaintiff to pain
management for consideration of a series of 3 epidural injections, and if those are
ineffective, she would then consider referring Plaintiff to a spine surgeon. (Id.) For
Plaintiff’s chronic pain, Dr. Badhwar planned to switch Plaintiff from his current maximum
dose of Gabapentin 900 mg three times daily to Lyrica, starting at 50 mg twice daily and
increasing to 100 mg twice daily, and if that is ineffective, to refer Plaintiff to pain
management for further interventions. (Id.) Dr. Badhwar noted Plaintiff was currently
taking Topamax for chronic headaches and if the cognitive side effects were intolerable,
he should consider switching to Nortriptyline. (Id.) Because current imaging showed no
neurological explanation for Plaintiff’s fecal incontinence, Dr. Badhwar recommended a
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referral to gastroenterology or urology for further evaluation, and Dr. Badhwar planned to
refer Plaintiff to rheumatology for possible fibromyalgia “[g]iven the widespread pain and
symptoms out of proportion to imaging findings.” (Id.) Dr. Badhwar also planned for
repeat blood work for autoimmune markers and to “follow up after specialist evaluations
and medication changes.” (Id.)
A right shoulder MRI performed on July 9, 2025, revealed: “1. Scarring of the
anterior superior glenoid labrum compatible with interval healing of a previously
characterized tear. 2. otherwise normal MRI right shoulder.” (Doc. 36-23 at 6–7.)
On July 9, 2025, NP Slattery issued an Offsite Healthcare Authorization for Plaintiff
to have “cardiology clearance” prior to “pending cubital tunnel release surgery with ortho.”
(Doc. 36-10 at 3.) Slattery wrote: “[Plaintiff] has severe [pulmonary arterial hypertension]
on opsumit and adempas yielding him high risk for surgical interventions. Defer cardiac
clearance to his local established cardiologist.” (Id.)
On August 6, 2025, Plaintiff saw an outside provider, DNP Sorrelle, for cardiac
clearance to receive cubital tunnel release surgery. (Doc. 36-11 at 2.) Following an exam,
Sorrelle indicated Plaintiff “may proceed with planned surgery from a pulmonary
perspective with the following recommendation of avoiding general anesthesia,
hypervolemia and maintaining SpO2 above 94% during procedure.” (Id. at 3.)
2. Discussion
Plaintiff’s Motion seeks consultations with orthopedic specialists regarding his c-
spine condition and right shoulder tear, a c-spine epidural injection as recommended by a
pain management specialist, cubital tunnel nerve entrapment surgery recommended by an
orthopedic surgeon, and an appointment with Plaintiff’s treating neurologist. (Doc. 5-1 at
1–2.)
There is no dispute Plaintiff’s orthopedic and neurological issues are “worthy of
comment or treatment” as revealed by his medical records showing he has been receiving
care at the prison; attending consultations with outside specialists; undergoing testing and
imaging; taking medications; and receiving nerve blocks, epidural injections, and physical
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therapy, as well as surgical recommendations for his left ulnar nerve and shoulder. This
evidence satisfies the objective prong of the deliberate indifference analysis. See
McGuckin, 974 F.2d at 1059–60. The Court will therefore turn to the subjective prong of
the deliberate indifference analysis for each of Plaintiff’s requests for relief.
a. C-Spine Consult and Epidural Injection
The record reflects Plaintiff has suffered c-spine pain since mid-2023. On May 13,
2024, Plaintiff had a c-spine MRI, which showed advanced degenerative spinal stenosis at
C5–C6 with moderate right and mild left foraminal narrowing. In August 2024, Plaintiff
saw Dr. Badhwar, a neurologist, who started Plaintiff on Gabapentin for pain and told
Plaintiff he needed an orthopedist to review his MRI and c-spine issues. In September
2024, after increased Gabapentin failed to reduce Plaintiff’s c-spine pain, Dr. Badhwar
recommended Plaintiff consult with a pain management specialist for his continuing severe
c-spine pain. In December 2024, Dr. Badhwar again referred Plaintiff to pain management
for consideration of epidural injections and recommended physical therapy for neck and
back pain, sleeping on an egg create mattress topper, and a follow-up appointment in 4
weeks or sooner to assess. Plaintiff saw a pain management specialist on January 30, 2025,
for a c-spine epidural injection but did not receive the injection because NaphCare had
failed to send the MRI report and take Plaintiff off Eliquis beforehand. Plaintiff attended
PT sessions in February and March 2025 but declined further physical therapy on March
17, 2025, due to poor tolerance and severe pain in his c-spine, left arm, and upper body.
On May 23, 2025, Plaintiff saw a pain management specialist, Dr. Saini, who assessed
Plaintiff with cervical spondylosis and cervical radiculopathy and administered a cervical
epidural steroid injection. When Plaintiff next saw Dr. Badhwar on June 9, 2025, he
continued to complain of widespread pain, and Dr. Badhwar planned to refer Plaintiff to
pain management for consideration of a series of 3 epidural injections for his cervical and
lumbar spine pain, and, if those were ineffective, to consider referring Plaintiff to a spine
surgeon. Dr. Badhwar also planned to switch Plaintiff from his current maximum dose of
Gabapentin to Lyrica, and, if ineffective, refer Plaintiff to pain management for further
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interventions and rheumatology to investigate possible fibromyalgia.
Defendants argue when Plaintiff saw the outside neurologist in August 2024, the
neurologist made medication recommendations but did not indicate the need for a referral
to an orthopedist. (Doc. 36 at 5.) Defendants assert Plaintiff continued to see the
neurologist and has been continuously seen and treated by his NaphCare providers and
provided various pain medications (both injections and narcotics), as well as PT and an
exercise plan. (Id. at 6–7.) Plaintiff replies Defendants use selective language from his
August 8, 2024 neurology report to minimize his c-spine injury, even though the same
specialist noted the c-spine MRI showed “advanced degenerative spinal stenosis.” (Doc.
60-2 at 5.) Plaintiff also notes the pain management specialist affirmed his symptoms and
pain were consistent with his imaging reports.
Based on this record, there is a question of fact whether Defendants were
deliberately indifferent to Plaintiff’s serious medical need when they failed to follow the
specialists’ recommendations for further c-spine epidural injections and possible referral
to an orthopedist or spine surgeon if pain management was ineffective. See Colwell, 763
F.3d at 1069; Snow, 681 F.3d at 988. Accordingly, the Court will grant Plaintiff’s request
to see an orthopedist for assessment of his c-spine issues and to determine if he should have
any c-spine epidural steroid injections. However, since it has been over six months since
the last specialist recommendation for c-spine epidural injections, and the current status of
Plaintiff’s c-spine issues is not known, the Court will not order that Plaintiff receive a c-
spine injection as recommended in June 2025. If Defendants fail to follow through with
the orthopedist’s recommendations, Plaintiff may file a new request for injunctive relief.
b. Right Shoulder Tear
A right shoulder MRI performed in November 2024 showed a “[f]ocal tear of the
anterior superior through anterior glenoid labrum without detachment.” (Doc. 36-14 at 9.)
In December 2024, Dr. Badhwar referred Plaintiff to orthopedics for further evaluation of
a potential labral tear. In January 2025, NP Welch noted Plaintiff was scheduled for
orthopedic surgery for his right shoulder, but UM initially recommended conservative
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treatment, including PT. Plaintiff attended PT sessions in February and March 2025 but
declined further physical therapy on March 17, 2025, due to poor tolerance. The next week,
Plaintiff told Defendant Welch PT caused severe pain in his c-spine, left arm, and upper
body.
Defendants assert a possible orthopedic follow up for Plaintiff’s labral tear was
stayed pending conservative treatment, which is common for this type of tear, and if the
conservative measures—including physical therapy and a cervical epidural steroid
injection on May 23, 2025—failed, then further orthopedic follow up would be considered.
(Doc. 36 at 7.) Defendants contend Plaintiff has acknowledged PT and injections were
working, and interventions provided relief for his neck/shoulder pain, bringing his pain
level down to “like a 3.” (Id.) Defendants assert Plaintiff was sent to pain management on
June 9, 2025, and a July 9, 2025 MRI of Plaintiff’s right shoulder noted healing of the
previously characterized tear and was otherwise normal. (Id.)
Plaintiff replies he said in January 2025 that his neck and shoulder pain was at a 3
because he had received an injection 6 days earlier and had some initial pain relief in his
shoulder, but the shot’s efficacy waned over time and the shoulder pain returned. (Doc.
60-2 at 6.) Plaintiff asserts he was informed another steroid shot could be administered in
3 months if his shoulder pain returned, but Defendants have not provided him with another
shoulder injection. (Id.) Plaintiff cites the July 9, 2025 shoulder MRI finding “[t]he subtle
features of the anterior superior labral tear on previous imaging are less pronounced on the
current study, probably representing some degree of interval granulation tissue formation
or healing,” and the provider’s ultimate impression the “[s]carring of the anterior superior
glenoid labrum [is] compatible with interval healing of a previously characterized tear.”
(Doc. 60-5 at 2.) Plaintiff argues Defendants have ignored his shoulder completely since
physical therapy was halted in March 2025, and “[t]o this day, there remains an intense,
fiery pain that flares through my sh[oulder] with certain movements. While range of
motion has improved, the movements are stilted, and I’m concerned about long term
permanent damage to my sh[oulder] as a result of the Def[endant]s’ handling of this
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injury.” (Doc. 60-2 at 6–7.) Plaintiff asserts the neurologist told him an orthopedic surgeon
is the type of specialist qualified to examine his shoulder injury and make an informed
decision as to the appropriate course of treatment. He further asserts no NaphCare
employee has bothered to examine his shoulder for nearly a year, and Defendant Welch
was a telehealth provider and UM has never seen him. (Id. at 6.)
Based on this record, there is a question of fact whether Defendants were
deliberately indifferent to Plaintiff’s right shoulder tear. Plaintiff was apparently scheduled
for shoulder surgery, but it was canceled in favor of alternative treatment. Plaintiff tried
the alternative treatment (PT and an injection), but the PT was too painful to continue and
the injection for pain wore off and the pain returned. Plaintiff has shown present-day harm
in the form of pain and limited range of motion in his right shoulder. Accordingly, the
Court will grant Plaintiff’s request to be seen by an orthopedist for his right shoulder injury.
c. Cubital Tunnel Nerve Entrapment Surgery
Nerve testing in October 2024 showed left ulnar neuropathy at Plaintiff’s elbow. In
December 2024, Dr. Badhwar referred Plaintiff to a hand surgeon for his cubital tunnel
syndrome. On March 18, 2025, Plaintiff saw a surgeon who recommended cubital tunnel
surgery. Plaintiff’s left cubital tunnel release surgery was scheduled for May 30, 2025, but
was canceled with a note that it would be rescheduled pending clearance. When Plaintiff
saw Dr. Badhwar in June 2025, Dr. Badhwar planned to refer Plaintiff to an orthopedic
surgeon for evaluation and possible rescheduling of the cubital tunnel release surgery.
Based on this record, there is a question of fact whether Defendants were
deliberately indifferent to Plaintiff’s serious medical need when they failed to follow the
specialists’ recommendations for cubital tunnel release surgery. See Colwell, 763 F.3d at
1069; Snow, 681 F.3d at 988. However, since months have passed since the last
recommendation or referral was made, the Court will not order Defendants to schedule the
surgery but will instead order Defendants to send Plaintiff to the appropriate
specialists/surgeons to determine if surgery is still warranted. If Defendants fail to follow
the specialists’ recommendations, Plaintiff may file a new request for injunctive relief.
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d. Appointment with Plaintiff’s Treating Neurologist
Plaintiff’s Motion seeks an order for Defendants to schedule Plaintiff to see his
treating neurologist (presumably Dr. Badhwar) within 14 days. (See Doc. 5-1 at 2.)
The record reflects Plaintiff last saw Dr. Badhwar on June 9, 2025. At that
appointment, Dr. Badhwar planned to refer Plaintiff again for cubital tunnel surgery; to
refer Plaintiff to pain management for consideration of a series of 3 epidural injections for
his spinal pain, and if those are ineffective, to consider referring Plaintiff to a spine surgeon;
to refer Plaintiff to rheumatology for possible fibromyalgia; and to refer Plaintiff to
gastroenterology or urology for fecal incontinence. Dr. Badhwar also planned to switch
Plaintiff from Gabapentin to Lyrica for his chronic pain, and if that is ineffective, to send
him to pain management. She also said Plaintiff could switch to Nortriptyline for chronic
headaches if Topamax proved intolerable. Dr. Badhwar also planned for repeat blood work
for autoimmune markers and indicated Plaintiff was to “follow up after specialist
evaluations and medication changes.” (Id.)
Based on this record, there is a question of fact whether Defendants were
deliberately indifferent to Plaintiff’s serious medical need when they failed to follow Dr.
Badhwar’s recommendations for referrals to other specialists, for repeat blood work for
autoimmune markers, and for follow up with Dr. Badhwar after the specialists’ evaluations
and medication changes. Given that it has been over six months since Plaintiff last saw his
treating neurologist, the Court will grant Plaintiff’s request to be sent to see his neurologist.
C. GI Issues
1. Relevant Facts
In 2023, Plaintiff began experiencing GI problems with symptoms including severe
abdominal pain, bloating, diarrhea, indigestion, constipation, nausea, incontinence, loss of
appetite, and extreme food sensitivity. (Pl. Decl. ¶ 2.)
While hospitalized in April 2023, Plaintiff consulted with a dietician who
recommended Plaintiff take a nutritional supplement such as Ensure or Boost to obtain
necessary nutrients and to minimize his GI problems and pain. (Pl. Decl. ¶ 3.) When he
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returned to prison, Plaintiff received the recommended Ensure from April 2023 until
November 2024. (Id. ¶ 4.) On November 10, 2024, Plaintiff filed an HNR asking for his
Ensure to be renewed, but the response said the order had expired and would not be
renewed. (Id. ¶ 7.) After filing another HNR, Plaintiff met with Defendant NP Welch who
said she could not renew Plaintiff’s Ensure because a new policy precluded her from doing
so. (Id.) NP Welch noted in Plaintiff’s medical record that an order for Ensure had been
discontinued on November 7, 2024, because Plaintiff no longer qualified for Ensure as his
last BMI was 19.8 with a normal total protein and albumin level and he was able to eat
solid foods. (Doc. 36-26 at 2.)
On August 8, 2023, Plaintiff had a GI consult and Metamucil was recommended,
but NP Welch told Plaintiff Metamucil was “barred by policy as a security risk.”5 (Pl.
Decl. ¶ 5.) During a November 25, 2024 GI consult, a doctor explained Plaintiff needed
the medication Linzess to treat his irritable bowel syndrome with constipation (IBS-C)
condition and other symptoms, given that prior treatments and medications had failed.6 (Id.
¶ 8.)
On April 30, 2024, Dr. Abdul Nadir, MD, at Mountain Vista Medical Center in
Mesa, Arizona, performed a colonoscopy on Plaintiff due to Plaintiff’s complaints of
abdominal pain in the left lower quadrant. (Doc. 36-1 at 2.) The results indicated
Plaintiff’s colon and rectum appeared normal. (Id. at 3.) Dr. Nadir recommended a repeat
colonoscopy and follow up in a GI clinic. (Id.) Dr. Nadir also performed an upper GI
endoscopy due to Plaintiff’s complaints of heartburn and suspected esophageal reflux and
gastro-esophageal reflux disease. (Id. at 4.) The results showed Plaintiff’s esophagus,
stomach, and first and second portions of the duodenum were normal. (Id. at 4–5.) The
surgical pathology report of a stomach biopsy revealed “[m]ild chronic inactive gastritis
5 Plaintiff does not say who recommended Metamucil or did the GI consult, and the
Court did not locate a GI consult record from around this date.
6 Plaintiff does not say who recommended Linzess or did the GI consult, and the
Court did not locate a GI consult record from around this date.
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and reactive gastropathy, antrum. Oxyntic mucosa with changes suggestive of PPI effect.
Negative for H. pylori on H&E stain.” (Id. at 6.)
On November 25, 2024, Dr. Nadir saw Plaintiff for a follow-up visit, and Plaintiff
reported continued bloating, gas, diarrhea, constipation, nausea, and heartburn. He also
reported Miralax and simethicone were not helping, but his GERD was controlled with
Protonix 40 mg twice daily. (Doc. 36-2 at 2.) Upon examination, Dr. Nadir found
Plaintiff’s abdomen soft with no abdominal distension or tenderness. (Id. at 3.) Dr. Nadir’s
assessment was altered bowel function, abdominal bloating, functional abdominal pain,
IBS-C, GERD, and “CRC screening.” (Id. at 4.) Dr. Nadir’s plan of care was to start
Plaintiff on Buspar 5 mg three times a day before meals and Linzess 290 mg daily, continue
Metamucil and 40 mg of Protonix twice daily, and to return in 6 weeks.7 (Id.)
At a December 3, 2024 appointment, Plaintiff asked Defendant NP Thornberry why
Linzess had been denied despite the gastroenterologist’s recommendation, and Thornberry
said insurance companies often will not cover medications like Linzess due to cost,
7 Buspar is the brand name for Buspirone, which “is used to treat certain anxiety
disorders or to relieve the symptoms of anxiety.” Mayo Clinic, Buspirone (oral route), at
https://www.mayoclinic.org/drugs-supplements/buspirone-oral-route/description/drg-
20062457 (permalink: https://perma.cc/2Y6E-GBL6).
Linzess is the brand name for Linaclotide and “is used to treat irritable bowel
syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC). It works
by increasing intestinal fluid secretion, which helps ease the passage of stools and relieve
the symptoms of constipation.” Mayo Clinic, Linaclotide (oral route), at
https://www.mayoclinic.org/drugs-supplements/linaclotide-oral-route/description/drg-
20075770 (permalink: https://perma.cc/HH4H-244G).
Protonix is the brand name for Pantoprazole, which “is used to treat certain
conditions in which there is too much acid in the stomach. It is used to treat erosive
esophagitis or ‘heartburn’ caused by gastroesophageal reflux disease (GERD), a condition
where the acid in the stomach washes back up into the esophagus. This medicine may also
be used to treat Zollinger-Ellison syndrome, a condition where the stomach produces too
much acid.” Mayo Clinic, Pantoprazole (oral route), at https://www.
mayoclinic.org/drugs-supplements/pantoprazole-oral-route/description/drg-20071434
(permalink: https://perma.cc/PP8F-REJW).
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implying cost was the reason Linzess was denied for Plaintiff. (Pl. Decl. ¶ 9.) When
Plaintiff saw NP Thornberry on December 10, 2024, he told her Buspar was not providing
him any relief for his painful GI symptoms, but Thornberry said Plaintiff had to continue
taking Buspar to comply with “UM’s ATP” (presumably, UM’s alternative treatment plan)
if he wanted to be approved for Linzess in the future. (Id. ¶ 10.) When Plaintiff saw
Defendant Welch on December 23, 2024, Welch said she agreed wholeheartedly with the
gastroenterologist that Linzess was the appropriate medication and she would fight for its
approval. (Id. ¶ 11.)
On December 27, 2024, NP Welch entered the following “Quick Note” in Plaintiff’s
medical record:
Medical provider alert: Patient was told that he needed to try
Buspirone for 30 days before Linzess would be considered.
(Doc. 60-5 at 14.)
In February 2025, NP Welch told Plaintiff his follow up with the gastroenterologist
had been denied and UM had decided to go with an alternative treatment plan, which she
referred to as “risk MD.” (Pl. Decl. ¶ 12.) In March 2025, Welch told Plaintiff “risk MD”
had given her a plan to prescribe Senna and Pepcid along with antibiotics for 2 weeks to
treat diverticulitis. (Id. ¶¶ 13, 14.) Plaintiff later told Welch the antibiotics produced severe
diarrhea and fecal incontinence, and he continued to have nausea, severe pain, and a sudden
urge to use the bathroom, but he agreed to finish the course of antibiotics rather than appear
noncompliant with the latest alternative treatment plan. (Id. ¶ 14)
On March 10, 2025, NP Welch prepared an “eConsult Record” for gastroenterology
with the following clinical question and supporting details:
44-year-old male patient with a medical history of GERD,
Abdominal Bloating, Functional Abdominal pain, IBS-C,
Diarrhea, Intermittent Fecal incontinence, Altered Bowel
Function, Extensive back pain with occipital neuralgia,
degeneration, left ulnar neuropathy, Primary pulmonary
hypertension, Chronic thromboembolic pulmonary
hypertension, long term anticoagulant therapy. Patient has
been seen in the past by GI with no relief or resolution to his
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continued abdominal pain, with constipation/ diarrhea, change
in appetite, and weight loss. Last GI appointment 11/2024 they
recommended he start Buspar 5mg TID with meals and Linzess
290mg QD before meals along with continued Protonix 40mg
BID and Metamucil. It was suggested he follow-up 6 weeks.
He was denied the Linzess and within the correctional setting
no patient is allowed Metamucil. He did try for 30 days the
Buspar with no positive results subsequently we [discontinued]
the medication. He has been on every stomach medication we
have access to and nothing has helped completely.
(Doc. 36-2 at 9.) Plaintiff’s medications were listed as Eliquis, Fiber-Lax, Gabapentin,
Hydrocerin External, Loratadine, Multi-Vitamin, Omega 3, Opsumit, Pantoprazole
Sodium, Probiotic, Simethicone, Topiramate, and Vitamin C. (Id. at 10.)
On March 10, 2025, Dr. Ian Harnik, MD (board certified in internal medicine and
gastroenterology), from Arista/MD responded to this eConsult:
This sounds like a very difficult situation. He appears to have
Pulm HTN (on oxygen?) and chronic pain. However I am not
given a complete history/PMH/etc from the primary provider.
There is polypharmacy and it is stated that multiple drug trials
have not helped him. My tendency would be first to remove
any meds that are not necessary or helpful.
Adempas has several GI side effects listed; discuss with
prescribing MD whether they see this and consider with the
patient if symptoms started along with use of the medication.
Same for Topiramate (guessing the topiramate is for
headache?). If not needed then perhaps a different
neuromodulator could be tried (SSRI, TCA, remeron if not
tried before) for global IBS symptoms. There is no detail of
psych history however.
Consider CT abd/pelvis with oral and IV contrast given the
reported weight loss in association with his abdominal
complaints.
Consider empiric treatment for SIBO [(small intestine bacterial
overgrowth)]/IBS with xifaxan 550 TID x 14 days or if not
available cipro/flagyl or other substitute.
Consider low FODMAP diet or at least gluten and lactose free
if possible.
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Consider tapering off his PPI and getting to PRN H2RA or
PRN PPI use given lack of erosive disease on EGD and chance
it could cause bloating or diarrhea.
Stop probiotic and simethicone if not working.
Record suggests he is constipated without miralax but has
diarrhea with it, and also a history of incontinence. Cannot get
fiber and cannot get Linzess. Try to encourage high fiber diet,
adequate water intake and regular toileting. Perhaps senna 1–
2 tabs PRN if no BM for 2 days, or something like that. I
acknowledge it may be hard to make these changes in prison.
Please reconsult with further info (past or present) and/or
results of the interventions above.
(Doc. 36-2 at 11–12.)
2. Discussion
Plaintiff seeks a Court order for Linzess, Metamucil, and nutritional supplements
(presumably Ensure or Boost) as recommended by his treating specialists, as well as a
follow-up appointment with a gastroenterologist 4 to 6 weeks after receiving the Linzess,
Metamucil, and supplements. (Doc. 5-1 at 1.) Plaintiff asserts he has been compliant with
NaphCare’s prescribed GI treatments for two years, but he continues to suffer painful GI
complications daily that negatively affect his ability to live a normal life. (Pl. Decl. ¶ 15.)
Plaintiff asserts Defendants continue to deny him specialist-recommended treatments, i.e.,
Metamucil, Linzess, and a GI follow up, and they took away his specialist-prescribed
nutritional supplement (Ensure), which had provided some GI relief. (Id.)
Defendants respond Plaintiff’s Ensure was discontinued on November 7, 2024,
because the provider determined Plaintiff’s BMI was 19.8, he had a normal total protein
and albumin level, and he was able to eat solid foods, which made him ineligible for
Ensure. (Doc. 36 at 9.) They assert Linzess was initially denied “but only to first
implement the recommended alternative treatment plan of a trial of bulk-forming laxatives
such as fiber and a stimulant laxative.” (Id. at 8.) As an alternative to Metamucil, which
is prohibited by ADCRR policy, Plaintiff was prescribed Fiber-Lax (a pill) and Senna (a
tablet). (Id. at 8–9.)
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In his Reply filed November 5, 2025, Plaintiff asserts even though his GI symptoms
have not abated, Defendants have not followed up with Arista/MD, and they discarded the
CT scan recommendation and did not offer or discuss a FODMAP diet. (Doc. 60 at 5; Doc.
60-2 at 8.) Plaintiff further asserts Defendants’ denial of Linzess in favor of an alternative
treatment plan was disingenuous because other measures had been tried for over a year and
failed. (Doc. 60 at 5.) Plaintiff contends that by December 2024, he met Defendants’ own
criteria for Linzess but they continued to deny him the medication, and Defendant Welch
has told him during several appointments she agreed with the gastroenterologist’s
recommendations but Defendant NaphCare would not permit her to prescribe Metamucil
or Linzess. (Id.; Doc. 60-2 at 8.) Plaintiff asserts the March 10, 2025 GI e-consult with
Arista/MD was a means of further denying him Linzess and Metamucil, and even though
his GI issues have continued, Defendants have repeatedly denied him an in-person follow
up with Dr. Nadir. (Doc. 60-2 at 7, 8.) Plaintiff asserts his GI issues and pain have
disrupted his ability to lead a normal life, without fear of food, for almost three years. (Id.
at 8.)
There is no dispute Plaintiff’s GI issues are “worthy of comment or treatment” as
revealed by his medical records showing he has been receiving care at the prison,
consultations with outside specialists, and medications and supplements for these issues.
This evidence satisfies the objective prong of the deliberate indifference analysis. See
McGuckin, 974 F.2d at 1059–60. The Court will therefore turn to the subjective prong.
Here, the facts do not support the denial of Ensure amounts to deliberate
indifference. Although Plaintiff asserts an unnamed nutritionist recommended Ensure in
April 2023, there is no medical record with this recommendation, and outside specialists
Plaintiff has seen after April 2023 have not recommended Plaintiff continue taking Ensure.
There are questions, however, regarding the denial of Linzess and Metamucil as
recommended by the gastroenterologist in November 2024. After that recommendation,
Defendant Welch told Plaintiff ADCRR policy prohibited Metamucil and suggested
NaphCare would not prescribe Linzess due to cost, even though Welch thought Linzess
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was appropriate for Plaintiff. Another gastroenterologist, Dr. Harnick, whom NaphCare
consulted in March 2025, also seemed to suggest Metamucil and Linzess may be
appropriate for Plaintiff, but because those are not available to Plaintiff in prison, Dr.
Harnick attempted to find alternatives such as a high fiber diet and Senna. In addition,
Defendants have not cited any evidence supporting their statement Linzess was only denied
initially in favor of an alternative treatment plan, suggesting Linzess may be prescribed in
the future.
Based on this record, Plaintiff has shown a likelihood of success on the merits of his
deliberate indifference claim regarding the treatment of his GI issues and the denial of
Linzess and Metamucil. While the record shows Plaintiff has been receiving some
treatment, the evidence shows the treatment being provided at the time Plaintiff filed his
Motion was inadequate. A reasonable jury could find, in these circumstances, Defendants
failed to competently treat Plaintiff’s GI issues and acted with deliberate indifference.
Plaintiff has also demonstrated the threat of irreparable harm where he asserts he has
suffered GI issues and pain for nearly 3 years and those issues have disrupted his ability to
lead a normal life.
Accordingly, the Court will grant in part Plaintiff’s Motion for injunctive relief
regarding his GI issues. However, since it has been a year since Plaintiff saw a GI specialist
in person, the Court will require Defendants to return Plaintiff to the GI specialist for an
in-person follow up and, if the GI specialist continues to recommend Linzess and
Metamucil, Defendants must provide Linzess and Metamucil.8
IT IS ORDERED:
(1) Plaintiff’s Motion to Supplement Reply (Doc. 65) is GRANTED.
(2) Plaintiff’s Motion for Preliminary Injunction (Doc. 5) is GRANTED IN
PART as follows. Within thirty (30) days of the date of this Order, Defendants must:
8 ADCRR’s security concerns can be adequately addressed by administering the
Metamucil by a prison nurse. See Spar v. Mohr, No. 2:14-cv-546, 2015 WL 5895914, at
*10 (S.D. Ohio Oct. 9, 2015) (recommending district court judge grant preliminary
injunction for provision of Metamucil to prisoner); see also Doc. 100 in No. 2:14-cv-546
(adopting magistrate judge’s report and recommendation).
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a. Provide Plaintiff with a pulse oximeter and portable oxygen concentrator.
b. Schedule Plaintiff with an orthopedist to assess his cervical spine to
determine if Plaintiff should have c-spine epidural injection(s).
c. Schedule Plaintiff with an orthopedist to assess his right shoulder injury
and, if surgery is still recommended, provide the surgery.
d. Schedule Plaintiff with the appropriate specialist to determine if cubital
tunnel release surgery is still recommended and, if so, provide the cubital
tunnel release surgery.
e. Schedule Plaintiff to see his treating neurologist for follow up.
f. Schedule Plaintiff to see a gastroenterologist for follow up to see if
Linzess and Metamucil are still recommended, and, if they are still
recommended, provide Plaintiff with Linzess and Metamucil within thirty
(30) days of the gastroenterologist visit.
g. Follow all the specialists’ recommendations for treatment, including but
not limited to testing, scans, injections, medications, surgery, treatment,
medical equipment, referrals, and follow up.
h. This relief is narrowly drawn, extends no further than necessary to correct
the harm, and is the least intrusive means necessary to correct the harm.
See 18 U.S.C. § 3626(a)(2).
i. Plaintiff is not required to post bond.
(3) Plaintiff’s Motion for Preliminary Injunction (Doc. 5) is otherwise
DENIED.
Dated this 16th day of January, 2026.
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